Faculty of Medicine

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APPLICATION OF CERTAIN CARDIOLOGICAL AND KINESIOLOGICAL PROTOCOLS DURING THE PROCESS OF REHABILITATION OF THE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
(University of Tetova, 2024)
Denis ALIU
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Zhaku, Vegim
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This study focuses on evaluating the effects of a specific kinesitherapeutic treatment protocol with duration of 21 days on the functional and biochemical parameters in patients recovering from acute myocardial infarction. The rationale behind this investigation lies in the growing body of evidence suggesting that structured physical activity can positively influence cardiovascular health, functional capacity, and overall well-being. The study conducted once more proves the importance of physical activity on general health and the functionality of the cardiovascular system in particular.
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Thyrotoxicosis-Induced Reversible Dilated Cardiomyopathy: A Case Report
(AVES YAYINCILIK A.Ş., 2026-01-07)
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Manev, Nikola
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Thyrotoxicosis-induced cardiomyopathy (TCM) is a rare but severe complication of thyrotoxicosis, characterized by significant left ventricular systolic dysfunction. While heart failure (HF) symptoms may be common in patients with thyrotoxicosis, true cardiomyopathy remains uncommon, affecting less than 1% of these individuals. A 27-year-old previously healthy woman who presented with symptoms of severe thyrotoxicosis, including irritability, hair loss, persistent dry cough, hypertension, and tachycardia is reported. Thyroid tests revealed elevated levels of free triiodothyronine and thyroxine, with suppressed thyroid-stimulating hormone. Thiamazole and propranolol therapy were initiated. Two months later, her condition worsened, with fatigue, leg and abdominal swelling, and persistent cough. Echocardiography showed a severely reduced ejection fraction (EF 19%) and dilated cardiac chambers. N-terminal pro–B-type natriuretic peptide levels were elevated. She was managed with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and continued thyroid treatment. After 7 days, EF improved to over 40%, with reduced ventricular dimensions. Continued treatment led to progressive recovery. At the 18-month follow-up, echocardiography documented normalized chamber dimensions and preserved EF, confirming complete reversal of TCM. This case highlights the importance of early recognition and intervention, as prompt restoration of thyroid function and appropriate HF management are crucial for reversing cardiac dysfunction and improving outcomes.
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THE ROLE OF SHOCKWAVE INTRAVASCULAR LITHOTRIPSY IN THE TREATMENT OF HEAVILY CALCIFIED CORONARY ARTERY LESIONS: OUR FIRST EXPERIENCE
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025-12-17)
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Jovkovski, Aleksandar
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Manev, Nikola
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Introduction: Coronary artery disease (CAD) is typically a chronic, progressive, inflammatory disease of the coronary arteries caused by coronary atherosclerosis. Moderate-to-severe calcification is present in up to 30% of patients undergoing coronary angiography (CA). Calcified coronary artery lesions are one of the most complex and challenging lesion subsets in interventional cardiology. Shockwave intravascular lithotripsy (IVL) is a recently introduced calcium-modifying technique for the treatment of concentric, eccentric and nodular calcifications. Case presentation: We present a clinical case of a 73-year-old male complaining of intermittent chest pain. He was a non-smoker with a positive familiar history for CVD. He had previous myocardial infarction and stenting of the right coronary artery (RCA), previous CVI, paroxysmal atrial fibrillation, insulin-dependent type 2 diabetes, heart failure with mildly reduced ejection fraction (HFmrEF) and chronic kidney disease (CKD) stage II/IIIa. CA revealed heavily calcified CAD. A calcified lesion of the left anterior descending artery (LAD) was treated using a 3.0/12 mm Shockwave IVL balloon; and calcium cracks and fractures were confirmed by optical coherence tomography (OCT). We proceeded with an NC balloon and finally treated the lesion with a 3.5/15 mm drug-coated balloon (DCB). The calcified lesion of the RCA was treated with conventional techniques using guiding catheter extension, NC balloons and drug-eluting stent (DES). Conclusion: Heavily calcified coronary artery lesions remain one of the biggest challenges for interventional cardiologists. Shockwave IVL is designed for treatment of all types of heavily calcified lesions using acoustic waves (shock waves). IVL is safe and effective technique that will definitely strengthen the armamentarium for modern treatment of heavily calcified lesions.
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Assessment of the Motivation for Smoking Cessation among the Citizens of the Republic of North Macedonia
(Galore Knowledge Publication Pvt. Ltd., 2022-04-19)
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Prosheva, Sanja
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Marya Hubbard
Introduction: North Macedonia is among the top rated countries with high smoking prevalence with high rate of adult smoking 48.4%, and nearly 81.4% of the smokers started smoking before being 25 years of age. This paper will highlight the prevalence and public’s motivation on smoking cessation, broken down into age groups throughout the entire country of North Macedonia. Materials and Methods: The method is an analytical-descriptive method with cross sectional study, as a result to a quantitative-qualitative survey conducted among the population in 2021 with the collaboration of the Virginia Tech University and the NGO Link Across. Data from the Qualtrics housed surveys and the completed paper surveys were entered into an Excel DB. Descriptive statistics were generated for all questions. Bivariate data were analyzed using r. Results and Discussion: Smoking is widely spread among all age groups, but with a trend to decrease in numbers as the age is of a higher number - 32.2% belongs to the 18 to 24 year old group. Distribution by gender -57.8% female, 40.4% male. Younger age groups have the highest relative frequencies about the intention to quit smoking within one month. Approximately 16% of participants who were smokers and attempted to quit, were smoke free and successful in cessation. Majority of survey participants who attempted to quit were not successful and resumed smoking within 6 months. This is strong justification of smokers who attempt to quit needing a program that would guide them and maintain the attempts for cessation. Conclusions: New state programs for smoking cessation should be offered as soon as possible. Also regarding the changes in smoking protection laws, they should be analyzed; some of the changes need to be reverted regarding the law legislation of the new modern ways of tobacco use, which are on the rise all over the world.
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Health promotion challenges and opportunities in the Western Balkans: a review of contemporary policies and actions
(Frontiers Media SA, 2026-01-27)
Gabrani, Jonila
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Rommel, Alexander
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Anton, Aline
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Cilović-Lagarija, Šeila
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Grujić-Vujmilović, Dragana
Background Countries in the Western Balkans (WBCs) fall behind the European Union in implementing effective health promotion. This study explores the key components of national health promotion policies and action plans in Albania, Federation of BiH, and the Republic of Srpska, Montenegro, North Macedonia, and Serbia, with the aim of describing key action trends, gaps, and challenges, and recommendations for health promotion implementation improvement. Methods Within the framework of the “Western Balkan Strategic Partnership for Health Protection” (WASP) project, implemented in five WBCs on behalf of the Global Health Protection Programme (GHPP), 2023–2025, and using the” Ottawa Charter for Health Promotion” a descriptive observational study was employed, combining data and information provided from the desk review of national legal frameworks, country-specific reports and consultative meetings to describe health promotion policies and action plans implementation in the period from 2010 to 2022. Results WBCs highlight diverse national priorities, such as promoting education and healthy lifestyles (e.g., Albania, Serbia, Federation of BiH, and the Republic of Srpska), addressing health inequalities (e.g., Federation of BiH, and the Republic of Srpska, Serbia), and digital health systems. The strategies and action plans of WBCs have common health promotion goals, and challenges. Community engagement and enforcement of public health policies are insufficient. Preventive care services are notably underdeveloped in rural areas with inadequate healthcare infrastructure. Although legal frameworks show that there is commitment to health promotion, putting action plans into practice is still a challenge, especially when it comes to involving communities and focusing on prevention. Budget transparency and working together across the region could also be improved to better tackle health inequalities and build stronger health systems. Conclusion While WBCs demonstrate growing political commitment to health promotion, substantial gaps remain in translating strategies into sustainable action. Strengthening intersectoral collaboration, improving monitoring systems, securing stable financing, and expanding community participation are crucial for advancing equitable, prevention-oriented health systems across the region.
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EMERGING BIOMARKERS AT THE CROSSROADS OF CARDIAC, RENAL, AND HEPATIC DYSFUNCTION: A NEW ERA IN MULTIORGAN RISK STRATIFICATION
(Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2026-03-24)
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Petkovski, Dusan
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Vranjko, Elif
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Dobjani, Amela
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IMPACT OF TIME-TO-TREATMENT AND THROMBECTOMY TECHNIQUE ON OUTCOMESINACUTEISCHEMICSTROKE:ASINGLE-CENTERCOHORTANALYSIS
(Macedonian Association of Anatomists and Morphologists, 2025-06)
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Introduction:Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). Time-to-reperfusion is the most critical determinant of patient outcome. This study aimed to conduct a comprehensive analysis of key time metrics and the efficacy of MT at our institution, evaluating their impact on both angiographic and clinical results to identify areas for process optimization.Methods:We conducted a retrospective analysis of a cohort of 17 consecutive patients treated with MT for LVO stroke. We analyzed demographics, baseline clinical status (mRS), occlusion location, detailed time-to-treatment intervals, procedural techniques, and outcomes. The primary angiographic endpoint was successful reperfusion, defined as an extended Thrombolysis in Cerebral Infarction (eTICI) score of ≥2b. Clinical endpoints included functional outcome at 3 months, measured by the mRS, and the rate of symptomatic intracranial hemorrhage (sICH).Results:The mean patient age was 60.9 years, with a significant male predominance (70.6%). All patients presented with severe stroke (initial mRS 4-5), indicating a high-acuity cohort. The mean time from symptom onset to final reperfusion was prolonged at 505 minutes (8 hours 25 minutes). Despite this, a high rate of successful reperfusion (eTICI ≥2b) was achieved in 85.7% of patients, with complete reperfusion (eTICI ≥2c/3) in 57.1%. However, this technical success did not fully translate to clinical recovery, as a good functional outcome (mRS 0-2) at 3 months was achieved in only 30.8% of patients. The rate of sICH was 15.4%.Conclusion:Our center achieves high rates of technical success in reperfusion (85.7% eTICI ≥2b), comparable to international benchmarks. However, prolonged treatment delays are significantly attenuating clinical outcomes, with only 30.8% of patients achieving functional independence. This analysis underscores that procedural excellence alone is insufficient; optimizing system-wide time-to-treatment protocols isthe critical next step to improve patient recovery.
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‘What’ and ‘How’ to Measure in Allergy and Clinical Immunology: A Systematic Review of Core Outcome Sets and Outcome Harmonisation Processes
(Wiley, 2026-04-13)
Demidova, Anastasia
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Kiknavelidze, Nata
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Purtskhvanidze, Kristine
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Alieva, Elvina
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Ebrahimnejad, Mehrshad
Background Heterogeneity in outcome reporting and inconsistent use of outcome measurement instruments in allergy and clinical immunology research affects the comparability, synthesis, and clinical applicability of study findings. Harmonisation efforts, particularly Core Outcome Set (COS) development, aim to address these challenges by establishing standardised, evidence‐based and consensus‐driven outcome recommendations. This systematic review aims to map available COS and other harmonisation processes (HP) in allergy and clinical immunology, evaluate their methodological approaches, and assess their alignment with established development standards. Methods We systematically searched MEDLINE, EMBASE, and the COMET Initiative database until June 7, 2024 to identify COS and HP. We included studies if they provided recommendations on ‘core’ outcomes and/or outcome measurement instruments. Data extraction included disease focus, methodological approach, stakeholder involvement, and adherence to the Core Outcome Set‐STAndards for Development criteria. We synthesised the data at the initiative (process) level rather than the publication level because harmonisation initiatives are frequently iterative and reported across multiple papers (e.g., protocol, Delphi rounds, consensus statement, and subsequent instrument‐selection outputs). Results A total of 15,612 records were identified, with 44 studies (representing 22 initiatives both finished and in development) meeting inclusion criteria. The majority of initiatives focused on asthma ( n = 9), followed by eczema (atopic dermatitis n= 2; hand eczema = 1; eczema = 1), urticaria ( n= 2), allergic rhinitis ( n= 2), chronic rhinosinusitis ( n = 1), celiac disease ( n = 1), Immunoglobulin E (IgE)—mediated food allergy ( n = 1), eosinophilic esophagitis ( n = 1), and hereditary angioedema ( n= 1). No COS or HP addressed drug allergy, anaphylaxis, or other immune‐mediated allergic conditions. ‘Quality of life’ was consistently included in all COS with ‘signs and symptoms’, ‘exacerbations’ and ‘disease control’ frequently selected as well. Methodological approaches to COS development varied widely, with most employing Delphi surveys, consensus meetings, and stakeholder involvement, though levels of engagement differed. COS developers inconsistently adhered to Core Outcome Set‐STAndards for Development criteria, with some initiatives demonstrating rigorous methodology while others lacked transparency in key developmental steps. Conclusion This review highlights growing efforts to harmonise outcome assessment in allergy and clinical immunology. Major gaps remain in coverage and methodological rigour. Quality of life and patient‐reported symptoms are frequently recommended outcomes, yet definitions and measurement tools are inconsistent. Strengthening methodological consistency and expanding COS development to neglected areas are critical next steps to improve outcome reliability and comparability in the field.
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Pathohistomorphometric and Immuno-Histologic Changes in Early Arteriovenous Fistula Failure in Patients with Chronic Kidney Disease
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-07-15)
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Popov, Zivko
Background Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure. Materials and Methods Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67. Results The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation. Conclusion This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.
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The azygos vein as an alternative route for haemodialysis catheterisation
(SMC Media, 2025-05-20)
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Janushevski, Filip
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Introduction: Central venous catheterisation (CVC) is essential for haemodialysis in end-stage kidney disease, but superior vena cava (SVC) stenosis or occlusion often complicates long-term access. The azygos vein, a collateral drainage pathway, has been rarely used intentionally for catheterisation. Case description: We report on a 68-year-old male on haemodialysis with SVC perforation and stenosis due to prolonged catheter use. After a failed guidewire-assisted exchange, a non-tunnelled CVC was successfully placed in the enlarged azygos vein under fluoroscopy. The patient continued haemodialysis without complications, and the two-month follow-up confirmed catheter patency. Conclusion: This case demonstrates the azygos vein as a viable alternative for haemodialysis access in SVC stenosis.

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